Meta‐analysis of laparoscopic versus open liver resection for hepatocellular carcinoma

Jiang, Bin; Yan, Xiu-Fang; Zhang, Jianhuai

doi:10.1111/hepr.13061

Cited by 40 publications

(34 citation statements)

References 75 publications

(121 reference statements)

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“…However, minimally invasive liver resection remains limited to specialist centers with no general consensus regarding the translatability of minimally invasive liver surgery for improving clinical outcomes, although recent guidelines have been developed to guide surgeons as to its appropriate application (44). Several meta-analyses have published outcomes comparing robotic and open liver resections, which have demonstrated that RLR were associated with significantly lower overall complications, blood loss and blood transfusion along with a shorter hospital stay by 3-5 days (3,5). Oncologically, RLR achieves slightly better but still significant R0 resection rates (93% vs 94%).…”

Section: Discussionmentioning

confidence: 99%

“…A recent meta-analysis comparing LLR and open liver resection for the management of hepatocellular carcinoma has concluded that the use of the laparoscopic approach is associated with less intraoperative blood loss, the need for a blood transfusion, increased R0 resection rates and shorter length of hospital stay. However, LLR and open liver resections have similar overall survival, disease free survival and rates of recurrence (3). The laparoscopic approach was, however, associated with a shorter duration of hospital stay and lower overall complications (6).…”

Section: Introductionmentioning

confidence: 99%

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Robotic versus conventional laparoscopic liver resections: A systematic review and meta-analysis

et al. 2020

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Background: Theoretical advantages of robotic surgery compared to conventional laparoscopic surgery include improved instrument dexterity, 3D visualization, and better ergonomics. This systematic review and meta-analysis aimed to determine advantages of robotic surgery over laparoscopic surgery in patients undergoing liver resections. Method: A systematic literature search was conducted for studies comparing robotic assisted or totally laparoscopic liver resection. Meta-analysis of intraoperative (operative time, blood loss, transfusion rate, conversion rate), oncological (R0 resection rates), and postoperative (bile leak, surgical site infection, pulmonary complications, 30-day and 90-day mortality, length of stay, 90-day readmission and reoperation rates) outcomes was performed using a random effects model. Result: Twenty-six non-randomized studies including 2630 patients (950 robotic and 1680 laparoscopic) were included, of which 20% had major robotic liver resection and 14% had major laparoscopic liver resection. Intraoperatively, robotic liver resection was associated with significantly less blood loss (mean: 286 vs 301 mL, p < 0.001) but longer operating time (mean: 281 vs 221 min, p < 0.001). There were no significant differences in conversion rates or transfusion rates between robotic liver resection and laparoscopic liver resection. Postoperatively, there were no significant differences in overall complications, bile leaks, and length of hospital stay between robotic liver resection and laparoscopic liver resection. However, robotic liver resection was associated with significantly lower readmission rates than laparoscopic liver resection (odds ratio: 0.43, p = 0.005). Conclusion: Robotic liver resection appears to offer some advantages compared to conventional laparoscopic surgery, although both techniques appear equivalent. Importantly, the quality of evidence is generally limited to cohort studies and a high-quality randomized trial comparing both techniques is needed.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Robotic versus conventional laparoscopic liver resections: A systematic review and meta-analysis

et al. 2020

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“…Specific to the treatment of HCC, the safety and efficacy of the laparoscopic approach has been evaluated in several meta-analyses and propensity score analyses. These studies demonstrated the equivalent or superior perioperative outcomes of laparoscopic compared to open resection [32,33]. In a propensity score analysis, the overall and disease-free survival were similar and for the secondary outcomes, the laparoscopic group had shorter hospital stay, lower morbidity, with fewer transient liver failure and wound complications, and a larger tumor margin [34].…”

Section: Laparoscopic-assisted Partial Hepatectomymentioning

confidence: 91%

Surgical Resection in HCC

Labadie¹,

Sullivan²,

Park³

2018

Liver Cancer

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Hepatocellular carcinoma (HCC) is a deadly disease. Its incidence is rising worldwide without significant improvement in survival in spite of improving therapies. A wide array of treatment options for HCC exist and include surgery, catheter-based therapies, radiation and systemic therapy. These modalities are often used in combination for optimal management in a multidisciplinary approach. Surgical resection remains one of the only curative therapeutic options for HCC, although it is indicated in select patients with localized disease. Herein, we cover the role of surgical resection in the management of HCC, reviewing the perioperative and operative considerations, in addition to highlighting the advances in minimally invasive surgery and novel navigation technologies.

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“…The last decade, several meta-analyses of laparoscopic vs. open resection for HCC have been published [16][17][18][19][20][21][22][23]. These meta-analyses have analyzed and compared the results of many nonrandomized control trials and case-matched studies.…”

Section: Laparoscopic Liver Resection For Hccmentioning

confidence: 99%

“…Jiang et al [16] reported the superiority of laparoscopic liver resection (LLR) concerning the reduced intraoperative blood loss and blood transfusion, the expansion of the pathologic resection margins, the increase of R0 resection, and the shorter length of hospital stay. Laparoscopic resection has similar OS, DFS, and recurrence rate as open liver resection (OLR).…”

Section: Bmentioning

confidence: 99%

Novel Techniques in the Surgical Management of Hepatocellular Carcinoma

Ntomi¹,

Πασπάλα²,

Schizas³

2018

Liver Cancer

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Hepatocellular carcinoma (HCC) is the most common primary liver malignancy with cirrhosis preceding its development in most cases. Surgical resection remains the primary therapeutic option despite the recent emergence of locoregional therapies. Novel surgical techniques are being proposed to overcome the limitations of traditional anatomical open liver resection. Laparoscopic resection is a safe and effective alternative to open liver resection, especially for left lateral or peripheral segment tumors. It is associated with less postoperative morbidity, intraoperative blood loss, and medial hospital stay with no difference in oncological outcomes. Robotic-assisted liver resection overcomes the technically difficult resection of tumors located at the posterosuperior segments with similar outcomes to laparoscopic resection. Associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) procedure allows resection in patients with HCC, and associated major vascular resection or small future liver remnant (FLR) with long-term results yet to be announced. For patients with small solitary tumors or poor liver function, nonanatomical liver resection is a feasible therapeutic option due to minimal postoperative morbidity and similar oncological results of anatomical resection.

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Meta‐analysis of laparoscopic versus open liver resection for hepatocellular carcinoma

Cited by 40 publications

References 75 publications

Robotic versus conventional laparoscopic liver resections: A systematic review and meta-analysis

Robotic versus conventional laparoscopic liver resections: A systematic review and meta-analysis

Surgical Resection in HCC

Novel Techniques in the Surgical Management of Hepatocellular Carcinoma

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